2D shear wave elastography in evaluation of prognostic factors in breast cancer

Purpose

To evaluate the reproducibility of the 2D shear wave elastography (2D-SWE) method and to identify the prognostic factors of breast lesions.

Methods

In this prospective study, 44 female patients were consecutively included from January 2020 to September 2021. All patients showing visible masses at B-mode ultrasound underwent to clinical evaluation, followed by qualitative and quantitative 2D-SWE by two different operators with over 15-year and 2-year experience, respectively. Subsequently, patients underwent to surgical treatment after core needle biopsy. Reproducibility of qualitative and quantitative 2D-SWE was evaluated by Cohen’s kappa and intraclass correlation coefficient (ICC). Clinical, imaging, and histopathological data and 2D-SWE evaluations were analysed with Spearman's rank correlation test.

Results

The mean age of the patients was 55 years?±?12. The mean histological and ultrasound tumour size of were 23.1 mm?±?13.2 and 17.2 mm?±?10.2, respectively. The interobserver agreement showed a good reproducibility limited to the qualitative evaluation colour maps (Cohen’s kappa?=?0.603) and to the quantitative evaluation E ratio (ICC?=?0.771). Correlation analysis between the ultrasound and 2D-SWE values and the clinical-pathological parameters showed a significant relationship between E ratio and Elston–Ellis grading (P?<?0.030) and between tumour size and Elston–Ellis grading (P?<?0.041).

Conclusion

The 2D-SWE has shown good reproducibility among operators with different experience. It could be a promising tool in the evaluation of some prognostic factors in ultrasound visible breast cancer.

     

Gallstone prevalence and gallbladder volume in children and adolescents: an epidemiological ultrasonographic survey and relationship to body mass index

To assess the prevalence of gallstone disease and the behavior of gallbladder (GB) volume in childhood and adolescence, an ultrasonographic survey was carried out on 1570 subjects (age range 6-19 yr). Entered in the study were 750 males and 752 females (attendance rate, 95.7%). Gallstones were detected in two females aged 13 and 18 yr, respectively. None of the subjects in the study population had undergone cholecystectomy. The overall prevalence of gallstone disease was equal to 0.13% (0.27% in the female sex). A positive family history for biliary calculous disease was present in one of the two lithiasic girls. A progressive increase of GB volume with age was observed in both sexes, and figures were greater in males, than in age-matched females. A positive and statistically significant relationship was found between GB volume and body mass index (BMI) in both sexes. Obesity was recognized in 188 males (25.3%) and 167 females (25.0%). Obese subjects exhibited larger GB volumes than the nonobese age- and sex-matched controls. The study supports the view of a very low prevalence of gallstone disease in people younger than 20. It also provides information on GB size in relation to age, sex, and BMI.     

Responses to Heartbeats in Ventromedial Prefrontal Cortex Contribute to Subjective Preference-Based Decisions

Forrest Gump or The Matrix? Preference-based decisions are subjective and entail self-reflection. However, these self-related features are unaccounted for by known neural mechanisms of valuation and choice. Self-related processes have been linked to a basic interoceptive biological mechanism, the neural monitoring of heartbeats, in particular in ventromedial prefrontal cortex (vmPFC), a region also involved in value encoding. We thus hypothesized a functional coupling between the neural monitoring of heartbeats and the precision of value encoding in vmPFC. Human participants of both sexes were presented with pairs of movie titles. They indicated either which movie they preferred or performed a control objective visual discrimination that did not require self-reflection. Using magnetoencephalography, we measured heartbeat-evoked responses (HERs) before option presentation and confirmed that HERs in vmPFC were larger when preparing for the subjective, self-related task. We retrieved the expected cortical value network during choice with time-resolved statistical modeling. Crucially, we show that larger HERs before option presentation are followed by stronger value encoding during choice in vmPFC. This effect is independent of overall vmPFC baseline activity. The neural interaction between HERs and value encoding predicted preference-based choice consistency over time, accounting for both interindividual differences and trial-to-trial fluctuations within individuals. Neither cardiac activity nor arousal fluctuations could account for any of the effects. HERs did not interact with the encoding of perceptual evidence in the discrimination task. Our results show that the self-reflection underlying preference-based decisions involves HERs, and that HER integration to subjective value encoding in vmPFC contributes to preference stability.SIGNIFICANCE STATEMENT Deciding whether you prefer Forrest Gump or The Matrix is based on subjective values, which only you, the decision-maker, can estimate and compare, by asking yourself. Yet, how self-reflection is biologically implemented and its contribution to subjective valuation are not known. We show that in ventromedial prefrontal cortex, the neural response to heartbeats, an interoceptive self-related process, influences the cortical representation of subjective value. The neural interaction between the cortical monitoring of heartbeats and value encoding predicts choice consistency (i.e., whether you consistently prefer Forrest Gump over Matrix over time. Our results pave the way for the quantification of self-related processes in decision-making and may shed new light on the relationship between maladaptive decisions and impaired interoception.